End of the Beginning

The End of the Beginning

The medicine we knew at the school’s beginning in 1955 was almost unrecognizable at the end of the twentieth century. The science, the knowledge base, the organization, and the funding of health care had all undergone dramatic changes.

A Healthcare Revolution

Fifty years ago, we thought we might be able to conquer infectious diseases. Now we are facing rampant "new" diseases such as Human Immunodeficiency Virus (HIV) and Severe Acute Respiratory Syndrome (SARS), and are witnessing the development of resistance to antibiotics by many microorganisms, including the previously highly sensitive pneumococcus.

Fifty years ago, cardiac surgery was still in its youth, and mitral commissurotomies were high points of surgical endeavor. Now, rheumatic heart disease is very uncommon in the United States (although still common in parts of the third world).

Fifty years ago, we had only primitive antihypertensive drugs, which were difficult for patients to tolerate. Now, antihypertensive drugs are far more effective and better tolerated by patients.

Fifty years ago, the structure and mechanism of replication of DNA had just been described by Watson and Crick. Now, we are using therapeutic agents manufactured by recombinant techniques, and are beginning to see clinical applications of gene transfer therapy.

A Department Revolution

Not quite fifty years ago the Albert Einstein College of Medicine’s (Einstein) Department of Medicine had four full-time faculty members: Irving London, Charles Frank, Saul Korey, and I. Herbert Scheinberg. Now, just at Einstein, Jacobi, and Montefiore, the Department has over 400 full-time physicians and scientists.

In 1955, Einsteinmedical students paid just over $1,000 per year for tuition. Now, a medical student at Einstein can expect to pay over $34,000 per year in tuition.

A Foundation for the Future

As the end of the millennium approached, the Department of Medicine had met the challenge of becoming a vibrant and multifaceted entity. Over the past 45 years, the Department has grown exponentially. By the 1990s, it had responsibility for clinical services in four large hospitals, a major clinical and research faculty, training programs with over 350 residents and fellows, and a global budget that approached $100 million.

The Department over the previous 45 years had achieved tremendous success in all of its activities and was recognized throughout the academic community for the excellence of its programs. During the 1990s the “healthquake,” a term coined by Dean Dominick Purpura, arrived in full force, and presented new challenges and difficulties for academic medical centers in all of their activities. The Einstein Department of Medicine, with its very large teaching responsibilities and great dependence on both grants and hospital finances, needed to adjust its activities in practice, teaching, and research. Now was the time to adapt to the healthquake, to meet new challenges while at the same time striving to maintain core values and promote the traditional missions: education, the discovery and application of new knowledge, and provision of exemplary patient care.

Dr. Scheuer felt that the Department would benefit from appointment of a new leader, one who could deal with these emerging conditions in a more flexible manner. Therefore, he stepped down as Chairman confident that the basic strength of the department, its faculty and programs, would see it through the healthquake. The future will be different. However, building on the foundation of the Department as it now exists, with strong leadership and its record of long-term academic excellence and productivity, will continue to place this Department in the upper tier of American internal medicine.

Acknowledgements

In addition to the faculty members and residents named in the previous two articles and noted in the appendices, the authors truly appreciate the efforts and contributions of many others who made Einstein Department of Medicine a first class venue for patient care, teaching, and research.